The aging of the US population will have significant effects on health care and social services. Between 1990 and 2009 the population of older adults doubled in the US, as did the overall number of people in prison in the US. During this same period, the population of older adults in prison increased by more than three times, meaning that the demographic shift of population aging is happening at an even greater rate in US prisons than in the general population. This is expected to have large consequences on the costs of health care in the criminal justice system. An article in the Journal of the American Geriatric Society gives an overview of aging in the US prison population, a relatively understudied phenomenon.
Older prisoners have an average of three chronic medical conditions, a higher rate than both younger prisoners and non-incarcerated older adults. Studies suggest that older prisoners have around the same rates of severe mental illness as older non-prisoners (in contrast to younger adults, among whom rates of mental illness are higher in the prison population), but this may be due to underdiagnosis and undertreatment within prisons. The presence of cognitive impairment and dementia is also significantly higher among older prisoners than older non-prisoners.
Functional impairment is difficult to assess in older prisoners, given that the traditional measures of function for community-dwelling older adults, such as the ability to shop or balance a checkbook, are generally not applicable to prisoners. The article mentions a previous study that suggested a set of activities of daily living for prison, but notes that such activities may differ greatly across institutions. Prisons are generally designed around incarcerating younger prisoners, making it likely that functional impairment is very high among older prisoners.
The lack of geriatric models for health care in prisons is not only significant for older prisoners, their families, and prison employees, but has consequences for the larger population. Ninety-five percent of US prisoners will eventually be released, and while older prisoners have the lowest risk for re-incarceration among prisoners, they also have poorer social and health outcomes upon release. The high rates of communicable and other diseases among this population, as well as other social and medical risk factors, create a health care burden for both former prisoners and society as a whole.
The authors note that there are serious gaps in our knowledge about aging in prisons for a variety of reasons, including the ethical difficulties of conducting prison research and the often unsympathetic nature of the population. Improved geriatric and functional assessments in prison might not only reduce the burden of illness within the growing and graying US prison population, however, but also reduce costs for the criminal justice system and for health and social services in communities into which prisoners are released.
Williams BA, Goodwin JS, Baillargeon J, et al. Addressing the aging crisis in U.S. criminal justice health care. Journal of the American Geriatrics Society (2012); 60(6):1150-1156.